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CANYON MEDICAL PHARMACY, INC.
DSH180044 PIKEVILLE MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
PIKEVILLE MEDICAL CENTER, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180044
Entity Address
911 BYPASS ROAD
PIKEVILLE, KY 41501
Medicare Provider Number
180044
Participating Start Date
1/1/2007
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
CANYON MEDICAL PHARMACY, INC.
Pharmacy Address
7265 S REVERE PARKWAY, SUITE 902
CENTENNIAL, CO 80112
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/13/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
MICHELLE HAGY, CFO
(606) 430-3519
Contract Pharmacy Representative
CarepathRx Health System Solution
Ryan Rushing, Vice President, 340B Solutions
(512) 541-0665
Signed By Date
7/17/2017
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